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Quality Solutions

Improve quality with a comprehensive, innovative approach to manage HEDIS® performance.

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Enhance clinical quality performance

Rising medical costs, affordability pressure, ever-changing reimbursement models, increased regulatory requirements and public reporting cause health plans to increase focus on quality metrics.

Multiple vendors can be costly. By enhancing clinical quality performance, health plans can improve health outcomes and reduce the cost of care.

Leverage a powerful reporting solution

Our comprehensive quality measures reporting solution helps you:

  • Minimize data transfer
  • Expedite the audit process
  • Streamline all measures activity to maximize efficiency and help ensure successful NCQA, CMS and state submissions

We’re committed to help you maximize data and processes to increase accuracy and completeness of HEDIS and other quality program scores and performance: 

  • Cloud-based HEDIS reporting system
  • Medical record review support
  • Audit management
  • Performance assessment

Comprehensive quality management

Our solutions feature unique differentiators, helping meet the unique needs and desired results for health plans.

The quality measurement engine has both retrospective and prospective services. The quality measurement engine has both retrospective and prospective services.

A proactive approach to prospective quality measurement

Drive quality programs in the measurement year by identifying gaps in care while reducing retrieval costs for the upcoming season. An integrated comprehensive quality and risk adjustment process may reduce provider abrasion.

  • Supplemental data collection and review
  • Quality analytics as a service
Doctor discusses care options with senior patient
Healthcare professionals using reporting tools.

Retrospective services bring your quality efforts full circle

We help health plans maximize data and processes to increase accuracy and completeness of HEDIS and other quality program scores and performance. By enhancing clinical quality performance, health plans can improve health outcomes and reduce the cost of care.

  • Measurement reporting and submissions
  • Maximize HEDIS collection and streamline medical record review processes

Fact sheet

Medical Record Review

Learn how Optum can help maximize HEDIS collection and streamline medical review processes.

Overview

Quality Solutions

Learn how we enable health plans to manage regulatory quality measurement and reporting.

Fact sheet

Quality management

Learn how to maximize data and processes to increase accuracy and completeness of HEDIS and other quality program scores and performance. 

Learn how Optum can help maximize quality outcomes for members, health plans and providers

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).